External validation of a prognostic score for oesophageal cancer (PSOC) for patients treated with palliative intent in a resource-limited setting.

Authors

L Ferndale, S Bhadree, W C Chen

Published in

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde. Volume 116. Issue 6. Pages e5118. Jul 02, 2026. Epub Jul 02, 2026.

Abstract

Oesophageal cancer (OC) is common in South Africa (SA), where late presentation limits curative treatment. In resource- constrained settings, staging may not benefit patients with a poor prognosis. The prognostic score for oesophageal cancer (PSOC), based on Eastern Cooperative Oncology Group performance status scale, body mass index and serum albumin, was previously developed to predict short-term survival.
To externally validate PSOC in an independent cohort.
We performed a retrospective validation study using prospectively collected data from two public sector hospitals in KwaZulu- Natal Province, SA. Eligible patients had histologically confirmed OC and complete PSOC data, and were treated with palliative intent. The primary endpoint was survival ≥3 months. Logistic regression assessed associations between PSOC and survival. Discrimination was quantified using the area under the receiver operating characteristic curve (AUROC), calibration with the Hosmer-Lemeshow test and accuracy with the Brier score. Secondary analyses evaluated overall survival (OS) with Kaplan-Meier and Cox models.
We included 465 patients (mean age 61 years; male:female ratio 1:1), 97% with squamous cell carcinoma. Higher PSOC scores predicted improved survival (score 4 v. 0: odds ratio 11.87, 95% confidence interval (CI) 4.87 - 28.91; p<0.001). AUROC was 0.681 (95% CI 0.630 - 0.732) with good calibration (Hosmer-Lemeshow p=0.920). Median OS was 4.8 months, with significant survival differences across score groups (log-rank p<0.001). The Brier score was 0.190, indicating good predictive accuracy.
PSOC is a simple, validated tool for predicting short-term survival in OC, and may guide decisions on staging v. palliation in high-incidence, resource-limited settings.

PMID:
42563653
Bibliographic data and abstract were imported from PubMed on 07 Aug 2026.

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